Obamacare mandates too much

The president came to speak about the Affordable Care Act in Boston, and it's not hard to understand why. It's one of the few places in the nation where there's a chance of a receptive audience.

CYNTHIA STEAD

The president came to speak about the Affordable Care Act in Boston, and it's not hard to understand why. It's one of the few places in the nation where there's a chance of a receptive audience.

For years, I warned progressive friends that if we ever enacted national health insurance, they would be in for a shock because in Massachusetts we mandated far more coverage than other states, which was why our health insurance cost so much and why so many major carriers refused to write insurance here. They airily insisted that we would bring the rest of the nation up to our level rather than slip down to theirs. The Obama administration is trying to carry out that scenario, but it isn't the success they anticipated.

Nationally, there is much consternation about mandatory pregnancy coverage for all, but here in Massachusetts, we don't realize it isn't already standard. Back when I was an insurance agent, you had to present a client with a breakdown of how premiums were charged. When selling a policy to a single male, I was asked if that charge was for their girlfriend. I usually said that it was for them, but if they did get pregnant, they'd probably make so much money from the National Enquirer they wouldn't need the insurance coverage. It was mandatory for all — women past childbearing age, men, celibates, everybody. The underwriting theory was that since pregnancy coverage was state mandated, the only way to keep policies for women from costing twice as much as for men was to make everybody pay a little bit. But instead of explaining that, the state just removed the requirement to explain the premium, and kept the charge. Massachusetts is used to that.

Another controversy is about keeping your plan and doctor. It doesn't get explained that the vast majority of policies — about 80 percent — for people with health insurance are covered by employer-sponsored plans and the plans being discontinued are individual policies. In order to get Obamacare passed, the sympathetic issue of exclusion for pre-existing conditions was used as an example of why the law was so urgent. But the Kennedy-Kassebaum Act of 1996 had already addressed the issue of exclusion on employment-based plans and the only policies which still excluded pre-existing conditions or imposed waiting periods for coverage are the individual plans. Those rates are exploding since there can be no exclusion now, making the risk on those policies much greater. But Massachusetts banned individual policies many years ago so there won't be those increases here.

Deciding that some plans are not adequate even if people are happy with them is right out of the Massachusetts playbook, though. When then-Gov. Mitt Romney filed the bill to create mandatory health insurance, it was with an eye to limiting the state's ruinous expenses in the legally mandated charitable care funds, aka "free care," although there was nothing actually free to anyone but the recipient. When an uninsured person with a broken leg came to an emergency room, the state usually had to pick up the tab. Since young, healthy people are likely to be willing to gamble that they won't get sick, they often rejected their employer care, only to suffer an accident they couldn't pay for.

In the original plan, they were encouraged to buy a high-deductible plan for less premium, and combine that with a Medical Savings Account that could be built up to cover that deductible. Routine medical expenses would still have to be covered out of pocket, but when they showed up at the emergency room with torn cartilage and needing surgery, the hospital could at least collect the money in the savings account and charge the insurance policy for any further expenses. But then-House Speaker Sal DiMasi removed that option from the final law, and mandated expensive HMO coverage for all even though for a healthy person that was like keeping a lawyer on retainer when all you plan to do is write a will. But Massachusetts was already used to having to pay out money on premiums that might be better used saving for a health care emergency.

So when the president spoke, people in Massachusetts shook their heads wondering what all the fuss was about. Boston is the second most expensive city to live in, according to Forbes, and health insurance costs are a big part of that, but soon all the country will enjoy our mandates and costs. It's just a matter of time.

Cynthia Stead of Dennis is Cape Cod Times columnist. Email her at cestead@gmail.com.